Carbapenemase typing and resistance profile of enteric bacteria isolate with reduced sensitivity to carbapenems in a Lebanese tertiary care center

Objective: nowadays resistant bacteria represent worldwide a public health problem leading in some cases to a stalemate without any possible treatment. Therefore early detection and identification of carbapenemase producing gram-negative bacteria (GNB) is of crucial importance. Consequently we conducted a study in a tertiary care hospital to analyze the resistance phenotype of the carbapenem resistant GNB (CRGNB). Methods: we collected all the CRGNB from September 2014 till January 2016, we took randomly 40/126 strains and performed a sensitivity test in addition to a real time multiplex PCR to detect the exact carbapenemase coding genes (bla SPC , bla IMP1, bla VIM , bla NDM , bla KPC , et bla OXA-48). The studied strains were: Escherichia coli (70%), Klebsiella pneumonia (20%), Enterobacter aerogenes (2,5%), Enterobacter cloacae (2.5%) et Klebsiella oxytoca (2.5%). Results: 100% of the studied strains were intermediate or resistant to ertapenem, 85% intermediate or resistant to imipenem and/or meropenem. 33 / 40 strains (82.5%) are bla OXA-48 positive et one strain (2.5%) is bla NDM positive. the OXA-48 were urinary strains of E coli. 6 / 40 strains (15%) did not express carbapenemase genes in molecular studies. Conclusion: we note a marked emergence of CPGNB especially bla OXA-48 with high resistance pattern leading to narrow therapeutic options. This requires a rapid detection of such strains of GNB so that to initiate quickly the right preventive and therapeutic measures to avoid hospital epidemics with disastrous consequences

Antibiogram of bacterial isolates from clinical specimens during 2018-2020 at Al-Aqsa hospital, Gaza, Palestine

Background: The increased resistance of microorganisms to widely prescribed antibiotics in current medical practice has become a major challenge. Healthcare-associated infections (HAIs) are complications of healthcare and linked with high morbidity and mortality. This study aims to investigate the susceptibility pattern of bacteria isolated from different bacterial infections to commonly used antimicrobials from Al-Aqsa hospital in Gaza Strip, Palestine. Methods: A total of 8062 various clinical specimens were collected from August 2018 to February 2020 and sent to Al-Aqsa medical microbiology laboratory for bacteriological culture. Specimens were processed based on the recommended microbiology procedures. The modified Kirby-Bauer disc diffusion method was used for antimicrobial susceptibility testing on Muller Hinton agar (MHA) as per the Clinical Laboratory Standards Institute (CLSI) guideline. Results: Enterobacteriaceae were the most frequent of all isolated pathogens (58.3%), followed by Staphylococcus spp (24.6%), Pseudomonas and Non-fermenters (6.9%), Streptococcus and Enterococcus (6.2%), and others (4.0). E. coli was the most frequent of all isolated pathogens (38.2%), followed by Coagulase Negative Staphylococci (14.9%), Klebsiella spp (14.2%), and Staphylococcus aureus (9.4%). The resistance of Gram-negative isolates for Piperacillin, Cephalexin, Cefuroxime, Cefotaxim, Ceftazidim, Ceftriaxone, Cefazolin, Co Trimoxazole, Nalidixic acid, Aztreonam, Amoxicillin/clavulanic acid, Meropenem and Techoplanin was between 62% and 92%. On the other hand, Gram-positive isolates (Staphylococcus spp) were found susceptible to Cloxacillin (65.0%), Erythromycin (47.3%), Clindamycin (81.7%), Levofloxacin (100.0%), Rifampicin (95.2%) and Vancomycin (89.2%). Conclusion: High rates of resistance were found among bacterial pathogens isolated from Al-Aqsa hospital. Regular antimicrobial resistance surveillance should be a continuous process to provide up-to-date information to physicians with local antimicrobial resistance data. Keywords: Antimicrobial resistance, Healthcare-associated infections, Gaza, Palestine.

The Effect of Vitamin D treatment on COVID 19- Patients, an Inverted Propensity Score Weighting (IPSW), and Inverted Probability of Treatment Weighting (IPTW) Analyzed Study

Background Vitamin D3 (1,25(OH)2 cholecalciferol) as a treatment for COVID 19 patients is being disputed, and a clear clinical benefit is not being confirmed. Methods A retrospective evaluation for COVID-19 patients who were treated with various cumulative doses of vitamin D. Data was extracted from the COVID-19 database, it included patients admitted to three hospitals in Amman, Jordan. Characteristics of patients were tabulated and compared for all-cohort, and propensity score index (PSI) adjustment, The comparison was based on two vitamin D strata ((≤ 149,000 i.u. and > 150,000 i.u.). Logistic regression analysis was utilized to predict recovery, the need for oxygen, and all-cause mortality for all-cohort, IPSW, and IPTW patients, based on vitamin D cumulative doses during their hospital stay. Results             1131 all-cohort and 768 PSI-adjusted patients were recruited. Except for antibiotics and antivirals, all other characteristics were balanced (P = NS). There were 1017 patients on vitamin D, 847 received cumulative ≤ 149,000 i.u., and 170 patients received cumulative dose ≥ 150,000 i.u. (Range 1000 – 385000). It was demonstrated that escalating cumulative doses of vitamin D did not contribute to the assessed outcomes; all-cohort patients (OR = 1.000, 95% C.I. 1.000 to 1.000), IPSW (OR = 1.000, 95% C.I. 1.000 to 1.000), and the IPTW (OR = 1.000, 95% C.I. 1.000 to 1.000). Conclusion             In our patients’ cohorts, we could not demonstrate a beneficial effect for vitamin D therapy in COVID-19 patients for recovery, the need for home oxygen, and all-cause mortality, by hospital discharge

Physico-Chemical and Microbiological Studies on Jordanian Honey and Propolis as Potential Self-Preserving Pharmaceutical Systems

The aim of this project was to study the physico-chemical and antimicrobial properties of Jordanian honey and propolis in order to determine their potential as pharmaceutical preservation systems. This study undertook a physico-chemical analysis of several Jordanian honeys and one propolis type, in order to evaluate several physico-chemical properties including, pH and free acidity, moisture content, ash content and HydroxyMethylFurfural content in three honey samples, and total flavonoid content in the propolis sample. The antimicrobial activity of honey and propolis samples was then evaluated by determining the minimum inhibitory concentration (MIC) against Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 8739, Pseudomonas aeruginosa ATCC 9027 and Candida albicans ATCC 10231. Subsequently, Honey 1 (H1) was selected for further study and combined with propolis to test their potential synergistic activity. Finally, a preservative effectiveness test was conducted in order to assess the possibility of using honey and propolis as natural preservatives in aqueous dosage forms, such as syrups. The results of this study showed that all the tested honey samples and propolis possessed significant antimicrobial activity against the standard test microorganisms, and that honey with propolis exhibited synergistic activity that enhanced their antimicrobial activity and resulted in up to 90% reduction in their MIC values. This study also confirmed that honey and propolis could be used as a natural preservative system for pharmaceutical formulae. Our results reveal the possibility of using honey-propolis mixtures as natural preservatives in oral aqueous pharmaceutical dosage forms and other local application products

Antimicrobial Susceptibility Pattern and Virulence Genes Detection in Citrobacter freundii Isolated from Patients of a Tertiary Care Hospital, Bangladesh : Antimicrobial susceptibility pattern and virulence genes detection in Citrobacter freundii

Background: Citrobacter freundii is an infrequent hospital acquired pathogen to cause different types of disease in clinical settings. This pathogen is associated with wide range of infections causing unpredictably high mortality rate of 30-60%.  Separation of this pathogen in health care settings is escalating and multidrug resistant strains are emerging. Therefore, this study aimed to detect antimicrobial resistance pattern and virulence genes among the isolated C. freundii. Methods: A total 500 samples (urine, stool, wound swab & pus, blood endotracheal aspirates and sputum) from patients with clinically suspected infections irrespective of age and sex were used in this study. Disc diffusion method was used to detect susceptibility pattern of antibiotics; colistin, tigecycline and fosfomycin susceptibility pattern was identified by minimum inhibitory concentration (MIC) method. Polymerase chain reaction (PCR) was done to detect potential virulence genes. Results: Among 27 isolated C. freundii, majority were resistant to amoxiclav (92.59%), trimethoprim-sulfomethoxazole (88.89%), cefotaxime and ceftazidime (85.19%) followed by ceftriaxone (81.48%), cefepime and ciprofloxacin (77.78%). MIC showed least resistance to colistin (29.63%), fosfomycin (11.11%) and tigecycline (7.41%). PCR was positive for via B gene (48.15%)   and lt-A gene (25.93%). hly A, lt, lt-h genes showed negative results. Conclusion: Antibiotic resistance found in this study is quite worrisome as widespread resistance is seen among the bacteria isolated from human infection. Also, virulence genes play important role in C. freundii infection

Prescribing oral amoxicillin for orofacial infections; pharmacokinetic perspectives: a review article

Despite the continuous efforts to synthesize new antibacterial compounds, most are still at a pre-clinical stage and shortage of new antibiotics is anticipated. Therefore, it is necessary to make the best use of currently available agents. Amoxicillin is the most commonly used antibiotic for treatment of orofacial infections as well as prophylaxis of endocarditis in children and adults. Understanding the pharmacokinetics of drugs helps to shape the appropriate clinical practices and provide guidance for clinicians. Clinical guidelines for prescribing have been established and explained in several resources. However the pharmacokinetic basis for prescribing is probably an underestimated and less tackled area among clinicians. Therefore, we critically reviewed the literature is to describe pharmacokinetics of oral amoxicillin in orofacial infections to provide better understanding of the guidelines and aid evidence-based prescribing practices. &nbsp

Co-infection in patients with COVID-19 in Tripoli Northern Lebanon: germs involved and antibiotic sensitivity profile.

Introduction: A considerable proportion of patients hospitalized with coronavirus disease 2019 (COVID-19) acquired bacterial infections. The aim of this study was to investigate the etiology and antimicrobial resistance of bacterial co-infection for more informed antimicrobial treatment. Methods: This retrospective study reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Northern Lebanon, Nini Hospital between august 2020-september 2021. According to the inclusion and exclusion criteria, patients who acquired bacterial infection were enrolled. Demographic, etiology and antimicrobial resistance data of the co-infection were collected. Results: The rate of infection by Gram-negative bacteria was 61.7%, while the rate of infection by Gram-positive bacteria was 23.4%. Escherichia coli was the dominant species isolated in this study (25.5%), followed by Candida spp (14.9%). With regard to fungal infection, there were 14.9% cases of yeast infection. The respiratory infection was the majority (42.5%), followed by blood infection (32%) and urine infection (25.5%). The analysis of antibiotics sensitivity results showed us that 44.4% of isolated Enterobacteriaceae were resistant to carbapenem, 16.66% were secretors of ESBL. We noted that 27.77% of Enterobacteriaceae were XDR. All isolates of Staphylococcus aureus were resistant to the methicillin. Conclusion: Bacterial co-infection may occur in patients hospitalized with COVID-19 and lead to high mortality. Gram-negative bacteria, especially Escherichia coli, S. maltophilia, and P. aeruginosa were the main bacteria, and the resistance rates of the major isolated bacteria were generally high. Keywords: COVID-19, co-infection, antibioresistance, Lebanon

CMV reactivation in COVID-19 patients: pouring fuel on the fire

Severe SARS-CoV-2 infection could promote CMV reactivation, that further worsens disease prognosis. This study included admitted patients with recent COVID-19 for one year period in a tertiary hospital, having clinical criteria of CMV reactivation and positive CMV DNAemia. Fifteen of 559 COVID-19 patients were diagnosed with CMV reactivation (2.7%). 86.6% were male, with a mean age of 63.6 years. Immunodepression was significantly higher in the CMV positive group (p=0.008). Lymphopenia was significantly more important in patients who reactivated CMV (p=<0.001), whereas ferritin level (p=0.019) and IL-6 level (p=0.035) on admission appeared to be significantly lower in this group. There was no significant difference for COVID-19 treatments. ICU admission (p<0 .001) and bacterial infections (p<0.001) appeared to be significant for CMV reactivation. Also, the mortality was significantly higher in the CMV positive group (p=0.042). This study raises the possible incrimination of lymphopenia, immunosuppression, critical illness, and bacterial infections in CMV reactivation

Impact Of COVID-19 Pandemic On The Pattern Of Azithromycin Prescribing; A Review

Objective: Emergence of COVID-19 infection and its persistence globally for three years in a row (2020-2022) entailed several modifications in healthcare services, among which drug prescribing was an important outcome. This review aims to highlight changing trends in azithromycin prescribing during pandemic years. Methods: PubMed database was systematically searched for combinations of the following keywords: Antibiotics; Antimicrobial resistance; Azithromycin; COVID-19. Results: A total of 12 articles were included in this review. All included studies demonstrated a notable increase in azithromycin consumption during COVID-19 pandemic in Spain, Brazil, USA, India, Croatia, and Jordan. Healthcare systems worldwide should be prepared to address anticipated outcomes of increased azithromycin use particularly possible changing trends in azithromycin resistance, and systemic side effects of the drug

Susceptibility of multidrug-resistant nosocomial pathogens for the new antimicrobial agents in Jordan

Background To study resistance rates of multidrug-resistant bacteria (MDR) for new Cephalosporines before their widespread use in Jordan. Methods During September 2019 - May 2020, MDR-bacteria were prospectively collected from microbiology laboratories of three hospitals, susceptibility of the extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL), K. pneumoniae-carbapenemases strains (KPC), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant P. aeruginosa (CRPa), carbapenem-resistant A. baumannii (CRAb), and Methicillin-resistant Staphylococcus aureus (MRSA) were tested. Demographic details for patients were identified. Antimicrobials evaluated were ceftazidime-avibactam, ceftolozane-tazobactam, and ceftobiprole medocaril. Results Non-duplicate 263 MDR clinical isolates were collected from sterile sites; ESBL (128), P. aeruginosa (57), MRSA (37), KPC (22), A. baumannii (11), and CRE (n = 8). The age was dominated by the older age group (Age > 64, Pearson R = 0.985, R2 = 0.969, P = 0.000). Males were 143 and females 107 (P < 0.000). There were (194) isolate from the wards and (55) were from the ICUs. Sources were urine (96), blood (36), soft tissues (49), abdomen (24), URT (14), and osteo-skeletal (12). Clinical diagnoses were: UTI (90). Bacteremia (36), SSTI (45), IAI (23), pneumonia (17), URTI (13), osteomyelitis (11), and diabetic foot (6). The susceptibility of the ESBL-producing bacteria was 100% for meropenem, 99% for ceftazidime-avibactam, and 90% for ceftolozane/tazobactam. P. aeruginosa was, 73% for ceftazidime-avibactam, 62% susceptible to ceftolozane/tazobactam, 62% for meropenem, and 45% to ceftobiprole. CRE was 38% susceptible to ceftazidime-avibactam and KPC 15%, while ceftolozane-tazobactam susceptibility was zero, and 14% for CRE, and 0% for Ceftobiprole Medocaril. A. baumannii was 13% susceptible to ceftazidime-avibactam, meropenem 9%, and 2% for ceftolozane/tazobactam Conclusion Ceftazidime-avibactam and ceftolozane/tazobactam may be useful alternatives for the treatment of ESBL-producers and P. aeruginosa, though the MDR-bacteria demonstrated some resistance to the newly introduced agents before their widespread use in the country. &nbsp